Minimally invasive pancreatoduodenectomy: laparoscopic or robotic?

Abstract

Objective: Laparoscopic and robotic surgery are novel approaches to pancreatoduodenectomy (PD). Reported series of minimally invasive PD are small or not adequately controlled. The aim of this analysis is to report outcomes following laparoscopic and robotic pancreatoduodenectomy compared with the open procedure in a large, multi-center cohort. Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Participant Use File 2014 was queried to identify patients having undergone minimally invasive (MI) pancreatoduodenectomy (163/3092, 5.2%). MI-PD included laparoscopic and robotic approaches as well as converted cases. Patients with a hybrid approach, vascular resections, and other major concomitant organ resection were excluded. Propensity scoring was used to match cohorts of patients having undergone and open, laparoscopic, and robotic PD. Results: The median age was 65, and 56% were men. Fifteen percent of patients were pretreated with neoadjuvant therapy, 51% had pancreatic adenocarcinoma. Patient cohorts were similar with respect to patient demographics, comorbidities, neoadjuvant therapy, and pancreatic gland texture and duct size. Operative time was longer in patients having undergone MI-PD. Post-operative outcomes are shown in the table. Conclusion: Laparoscopic and robotic approaches to pancreatoduodenectomy are safe and can be performed with comparable morbidity and mortality but take longer to perform. A robotic approach may reduce the need for conversion to open surgery compared to traditional laparoscopy.Tabled 1Conversion to open (%)Operative time (min)Overall morbidity (%)CR-POPF (%)DGE (%)Percutaneous drain (%)30-day mortality (n, %)Length of stay (days)Open (n =530)–353.0*27.914.716.011.59, 1.710.7Laparoscopic (n =81)32.7†436.827.119.626.0†13.92, 2.511.0Robotic (n =77)12.5421.626.018.111.810.51, 1.310.9*P<0.01 vs Lap/Robotic.†P<0.05 vs RoboticCR-POPF: clinically relevant-postoperative pancreatic fistula; DGE: Delayed gastric emptying. Open table in a new tab *P<0.01 vs Lap/Robotic. †P<0.05 vs Robotic CR-POPF: clinically relevant-postoperative pancreatic fistula; DGE: Delayed gastric emptying.